UPDATE Weekly

North Carolina nursing facilities have been receiving payments for their capital costs through a Fair Rental Value (FRV) system since 2007. As designed, FRV provides rate recognition to providers who invest in new buildings or make improvements to their current buildings. After being in place for ten years, it is believed that improvements can be made to the FRV system to better reflect today’s nursing facility operations.

The North Carolina Health Care Facilities Association (NCHCFA) is working collaboratively with the North Carolina Division of Medical Assistance (NC DMA) to gather data related to FRV in order to modernize the current FRV system.

To develop an alternative methodology for FRV, we must collect data on square footage from each facility. Completion of this survey is extremely important because the data you provide may be used in future Medicaid rate setting for your facility. Earlier this week, an email regarding this survey was sent to each of our member facilities and corporate offices.

This survey can be completed in two different ways.

1. Survey Monkey – This option is designed for the entry of data one facility at a time.
2. Excel Spreadsheet – The Excel spreadsheet is designed to ease the data entry for multiple facilities. If desired, it can also be used to submit information for a single facility. Once completed, the file should be e-mailed to samc@nchcfa.org.

Regardless of which submission method you choose to utilize, it is recommended that you take the following steps:

— Download and print the PDF version of this on-line survey and use it as a worksheet.
— Review the FAQs at the end of the PDF survey.
— With a completed worksheet in hand, you will be able to complete the on-line survey in one sitting or the Excel file.

The deadline for data submission is Friday, June 15, 2018. If possible, we would appreciate receiving as many surveys as possible before the deadline. June 15th was set as the deadline in order to allow additional time for providers needing to prepare their December 31st year end cost reports.

Useful links:
PDF Copy of the Survey Worksheet
FRV Survey Link
FRV Excel Spreadsheet

If you have any questions on this process, please contact Sam Clark at samc@nchcfa.org or by phone at (919) 782-3827.

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Each month, the Division of Medical Assistance (DMA) publishes the Medicaid Bulletin. This publication typically contains articles on various topics benefiting Medicaid participating providers. The current issue includes articles on NCTracks provider trainings, re-credentialing for providers, and others.

To access the current issues, and other recent issues, click here.

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Recently, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year 2019 and Pre-Rule on Possible New Payment System.

This proposed rule includes several changes to the SNF system of Medicare Part A payments.

• 2.4% market basket increase effective October 1, 2018. This results in an estimated total increase in payments to SNFs of $850 million.
• An update in the wage index will have an impact on the rate changes that providers actually see. In some areas of North Carolina, the proposed wage index increased more than 3%, while other areas saw a decrease of almost 5%.
• In 2017, CMS proposed a new payment methodology called Resident Classification System Version 1 (RCS-1). One of the biggest changes under RCS-1 was the four direct care components based on patient characteristics rather than therapy minutes in determining the payment rate. In addition, under RCS-1, there would have been only two mandatory MDA assessments, the 5 day and a discharge assessment. Based on considerable stakeholder feedback, RCS-1 has been revised and renamed the Patient-Driven Payment Model (PDPM). While PDPM addresses the same goals as RCS-1 and follows a similar structure, there are five case mix adjusted payment components and the timing in the reduction of component payment payments.

The American Health Care Association (AHCA) has created a summary document with a highlights section and preliminary overview of the payment updates, the SNF value-based purchasing (VBP) program proposed new components, the IMPACT Act quality reporting additions, and an overview of the payment reform discussion. AHCA members may view this document by clicking here.

On Monday, April 30th, AHCA also hosted a Webinar on the proposed payment rule. For those who were unable to participate, you can view a recording of the Webinar through ahcancalED with your AHCA member log-in (required). Please e-mail educate@ahca.org with any questions about or issues accessing the recording.

As mentioned during the session, you can view CMS’ SNF Patient Driven Payment Model resources and tools, including the grouper tool, here.

The proposed rule can be viewed at https://www.federalregister.gov/d/2018-09015. Comments will be accepted on this rule until June 26, 2018. The CMS fact sheet is available here.

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Since January 1, 2018, NCHCFA has allowed Assisted Living Facilities (ALFs) in North Carolina to join the National Center for Assisted Living (NCAL) through NCHCFA’s affiliation with AHCA/NCAL. Any ALF that elects to join NCAL will be a member facility of NCAL but will not be a member of NCHCFA. Click here to review NCAL membership benefits!

If an ALF wishes to join NCAL, please e-mail Karen Lennon for membership dues information at KarenL@nchcfa.org or phone at (919) 782-3827.

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It’s time to register and make plans to join your colleagues from around the country in beautiful San Diego for the most valuable long term and post-acute care gathering of the year. You will be treated to fantastic education sessions designed to help you meet the challenges of today. Earn CEUs while learning from top-notch speakers, engaging in priceless discussions, and making connections with people you can call upon throughout the year.

Early bird registration discount ends July 20th! Click here to register now.

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The North Carolina Health Care Facilities Association will be presenting this workshop to our members for the fifth time! This workshop was offered across the state of NC in 2017 with great success and outstanding reviews. If you missed it last year, sign up today!

Servant leadership is a set of behaviors and practices that turn the traditional “power leadership” model upside down; instead of the people working to serve the leader, the leader exists to serve the people. When leaders shift their mindset and serve first, they unlock purpose and ingenuity in those around them, resulting in higher performance and engaged, fulfilled employees. As servant leaders, your purpose is to inspire and equip those you influence.

The goal of this workshop is to provide attendees with information and tools that are relevant, transformative, memorable, and actionable. You will learn and practice execution of the most critical skills needed for leading by serving first. You will come out of this course feeling energized and have a number of tools and skills you can start to apply immediately to empower your teams.

This workshop will be Thursday, May 24th in Greensboro, NC. It will be facilitated by Mark Gogal, a Human Resources Leader with over 25 years of progressive, global, and diverse human resources experience, practical business partnering expertise, strong organizational and analytical skills, and proven strategic management experience. Mark is an enthusiastic and passionate leader and presenter that has a multi-faceted background in developing and implementing core HR policies/practices to meet the changing business, legal, and labor compliance environment. He has worked in a variety of industries in the public and private sectors including healthcare. Mark truly enjoys developing others to reach their fullest potential both professionally and personally.

For the complete brochure and registration information, click here.

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NCHCFA Districts have scheduled their spring meetings. District meetings allow participants to interact with peers in a comfortable atmosphere, promoting valuable and productive conversation. Each space will be limited to 50 individuals. There will be a small registration cost of $35.00 to help with the speaker fee. Lunch will be provided.

This program will offer 4.0 contact hours for nursing home administrators. The North Carolina Health Care Facilities Association is a Registered Sponsor of continuing education with the NC State Board of Examiners for Nursing Home Administrators. Comments regarding the Registered Sponsor Course may be addressed to: NCBENHA, 3733 National Drive, Suite 110, Raleigh, NC 27612.

The agenda will include the following topics/presentations:

Agenda

10:00 AM – 10:30 AM
Alliant Quality (QIN-QIO) –Alliant Quality will present an update on NC’s facilities’ quality measures.

10:30 AM – 2:30 PM
All Clear Emergency Management Group, LLC – Will Moorhead, President and Owner of All Clear Emergency Management Group, LLC, will dive into the “how to” of the exercise requirement of the Centers for Medicaid and Medicare Services emergency preparedness rule. Learn how to design, conduct, and evaluate an exercise in a nursing home environment. The session will briefly review the CMS requirements, provide practical tips for efficiently completing a useful risk assessment, and examine the contents of a CMS compliant and practically applicable emergency plan. This review of the CMS requirements will demonstrate how exercise design is more easily accomplished when utilizing the best practices for risk assessment and emergency planning. Participants will be guided through information and steps that can be utilized for exercise design within their facility.

District III
May 22nd
Clapp’s Mountain Top Living Apartments
450 Mountain Top Drive
Asheboro, NC 27203
Click here for District III registration form

District V
May 23rd
Cypress Glen Retirement Community
100 Hickory Street
Greenville, NC 27858
Click here for District V registration form

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NCHCFA has a new benefit of membership in 2018—a monthly Lunch and Learn Webinar Series. NCHCFA will offer a one-hour Webinar on a timely and relevant topic to its members for no additional charge. There will be no CEUs offered for these Webinars.

The next Webinar in the series is scheduled for May 17th, from 12 noon-1:00 PM. Mark your calendar today! Webinar details are below:

Title: Therapy, Therapy, Therapy – Things Every SNF Needs to Know

Presenter: Iain Stauffer, Poyner Spruill, LLP, Rhonda Craig, RC Consulting

Therapy continues to be one of the most profitable services SNFs offer, as evidenced by the growth of short-term rehab units across the country. Nothing is more maddening than to develop a busy rehab program, only to have Medicare and/or Medicaid agency contractors recoup large sums of money for allegedly inappropriate or unnecessary therapy services. This Webinar will examine the common sources of problems that lead to issues with therapy services and claims for repayment, including documentation; coordination with outside therapy vendors; management of therapy staff and related issues. Providers need to know both before providing services, and after receipt of a repayment demand, how to manage the provision of therapy services and how to respond to claims for records and repayment/recoupment.

Click here to register!

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Quality Measure Overview

• Reports the percentage of low risk residents who lose control of their bowel or bladder in a 7-day look-back period.
• Resident will trigger this measure if the most recent Minimum Data Set (MDS) H0300/H0400 is coded as frequently or always incontinent.

Exclusions:

• Target assessment is admission, Medicare Prospective Payment System 5-day assessment, or readmission/return assessment.
• Resident has high-risk conditions such as severe cognitive impairment or total dependence in bed mobility, transfers, and locomotion.
• Resident does not qualify as high risk (see above) and both of the following two conditions are true: C0500 and C0700/C1000 coded as [99], [^], or [-].
• Resident does not qualify as high risk and any of the following three conditions are true: G0110A1, G0110B1, G0110E1 coded as [-].
• Resident is comatose or comatose status is missing.
• Resident has an indwelling catheter or status is missing.
• Resident has an ostomy or status is missing.
• Resident is not in the numerator and H300 or H400 is coded as [-].

MDS Coding Requirements
In the MDS:

• Include a look-back period of seven days.
• Select H0300 (urinary continence) if the resident is always continent, occasionally incontinent, frequently incontinent, always incontinent, not rated due to indwelling catheter, condom, or urinary ostomy, or has had no urine output for entire seven days.
• Select H0400 (bowel continence) if the resident is always continent, occasionally incontinent, frequently incontinent, always incontinent, not rated due to ostomy or has had no bowel movement for entire seven days.

Ask These Questions:

• Was the MDS coded per Resident Assessment Instrument (RAI) requirements?
• Is the staff member’s coding documentation accurate?
• Are underlying conditions reviewed and treated for potential causative factors for incontinence (e.g., diabetes, kidney dysfunction, hypertension, medication adverse side effects, etc.)?
• Was the resident evaluated for elimination patterns for at least three days and were toilet programs developed to address individualized patterns?
• Was the resident re-evaluated for elimination patterns whenever there was a change in cognition, physical ability, or urinary tract function?
• Is continence managed through a check-and-change program if the resident is not appropriate for a toilet program?
• Is there documentation to support the:
  • Implementation of an individualized, resident-specific toilet program based on an assessment of the resident’s unique voiding pattern?
  • Communication of the individualized program to staff members and resident through a care plan, flow records, and a written report?
  • Resident’s response to the program and subsequent evaluations?

To download the Tip Sheet, click here http://nursinghnc.webfactional.com/files/2018/04/QMtipsheet-bowelbladderincontinence-9-27-16-11SOW-GMCFQIN-C2-16-51.pdf

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STATEWIDE PROGRAM FOR INFECTION CONTROL AND EPIDEMIOLOGY (SPICE) is offering free education to prevent and control healthcare associated infections across the healthcare spectrum. Register now! All Webinars are 12:00 NOON to 1:00 PM

• Thursday, May 17, 2018 – Detecting and Responding to Outbreaks in LTCFs – http://tinyurl.com/y8yvve9p
• Thursday, June 21, 2018 – Identifying Multi-Drug-Resistant Organisms in Your Facility – http://tinyurl.com/ycrzcjzd
• Thursday, July 19, 2018 – Understanding Pneumococcal Vaccinations – http://tinyurl.com/y9tw99vc
• Thursday, August 16, 2018 – Job Title = Infection Preventionist…What Now? Part 1 – http://tinyurl.com/y9qhbmb3
• Thursday, September 20, 2018 – Job Title = Infection Preventionist…What Now? Part 2 – http://tinyurl.com/y92dsegh
• Thursday, October 18, 2018 – You’re NOT Alone…Top 10 LTC “Ask SPICE” Questions – http://tinyurl.com/y8ploxba

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The newly revised edition of this popular resource provides professional caregivers with easy-to-understand and powerfully effective ways to prevent, reduce, or eliminate the challenging behaviors of care recipients. Nearly 80% of long-term care residents exhibit some level of difficult behaviors stemming from a wide range of factors including depression, personal distress, declining physical function, or dementia. Caregivers will learn how to use this book’s proven intervention tools and strategies to identify and satisfy the basic human needs that underlie challenging behaviors, as well as to encourage and reinforce positive behaviors.

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #8350
AHCA MEMBERS $38.99

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Grand Friends for Life – One center shares the wonders of caring for elderly residents with preschoolers on site.

Provider Magazine Article

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The average human being will yawn over 250,000 times in their lifetime.

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